Friday, 22 May 2015

UNISON North West has produced an excellent policy statement on Devo Manc. They are rightly concerned by the blurred lines of accountability, future funding and how services will be delivered or commissioned in the future. http://www.unisonnw.org/unison-north-west-agrees-position-statement-on-devo-manc/
One of the key areas to be included in Devo Manc is health spending. Labour’s vision for greater integration of health and social care was a strong concept which the Labour Party placed as a central plank of its NHS policy. Devo Manc appeared to wrong-foot Andy Burnham pre-election and led to accusations of a policy rift with the regions Labour leaders. Whether this is true or not it appears to me that Andy Burnham is the critical friend who should be listened to.
When the fiscal policy of central government is one of cuts and on-going austerity they are always surprisingly keen to shift the blame to a local level for any negative impact of that policy. We only need to look at what has happened under the guise of the Localism Act. ‘Power to the People’ but Eric Pickles reserved himself no fewer than 122 separate powers of intervention. Because whilst a cuts led Government doesn’t want the blame for the negatives they will always want the true control through the Treasury purse strings. And that is where Burnham is right.

The funding crisis in the NHS will not be touched by the supposed £8 billion from the Tory Government. NHS England have identified a £30 billion shortfall by 2020. So what will happen to the devolved budget of Devo Manc when the health money runs out? No doubt the Devo Manc leaders have been assured of a fair settlement and up-rated budgets in line with what they should expect for health funding in the sub-regional area at current levels – and if not more. But the promised £8 billion extra funding for the NHS is only a little over 1% of the total NHS spending – it is small change in comparison to the scale of the problem.

The memorandum of understanding on Devo Manc points to estate rationalisation and better integration as being ways to generate efficiencies. However we should remember that properties can only be sold for a capital receipt the once. And ironically integration could be impeded by fragmented commissioned services rather than truly integrating public services with the ability to plan the NHS and social care strategically, whilst ensuring local accountability and governance. This leaves huge questions about the future viability of funding and who will ultimately be accountable.

Devo Manc as a concept is not at all a bad thing in itself. It seeks to address the obvious health inequalities that blight the sub-regional area but many of these health inequalities stem from poverty. Fiscal austerity will sap up any advances in addressing health inequality by perpetuating the root cause. The pre-election Labour pledges allowed for better regional accountability and allowing for the whole of the NHS resources to be more effectively deployed – preserving the N in the NHS. This apparent RHS – a regional health service – will not enhance the ability of the NHS and social care to deliver national and local solutions.

We have yet to see what Osborne’s laughably named ‘Stability Budget’ will contain but if it is more cuts to councils than there will be no hope of addressing the crisis in social care services. Whatever promises are made on the back of Devo Manc health inequalities can only truly be remedied by addressing the grinding and endemic poverty which blights whole swathes of the Greater Manchester region.

When the NHS and social care funding crisis catches up with the Devo Manc budget Greater Manchester leaders, dressing up as modern day Oliver Twists asking ‘please sir can we have some more’ from Osborne’s Mr Bumble, is unlikely to produce any more devolved gruel from the Treasury masters.